This article is transcribed from an interview given by Dr. Arun Gupta, a paediatrician and public health scientist to Nivarana in 2022
In the 1980s, a young paediatrician in Punjab began to grow disquieted by the health practices he saw. While babies were separated at birth from mothers for observation, bottle-feeding was considered the norm. “Meanwhile, rampant diarrhoea in the wards led to deaths of babies like ninepins,” says Dr Arun Gupta. There had been little to no mention of successful breastfeeding in his postgraduate training.
His concern grew when he conducted a small study among 100 mothers- all instructed to feed their newborns a particular formula. As the growing dependence of mothers on infant formula became evident, Dr. Gupta realised the lack of accurate information available to these parents. In addition, promotional ploys used by companies emotionally persuaded parents that formula feeds were better for their babies- which was categorically untrue. This led to him becoming a relentless advocate to champion the cause of breastfeeding against the tide of corporate interests.
“I challenged the Indian Paediatrics- an academic journal of the Indian Academy of Paediatrics as to why they got money from Nestle for advertisements,” says Dr. Gupta. At a time when multinational companies targeted new mothers with the promise of convenience and modernity, Dr. Gupta found allies in like-minded paediatricians and a public health group VHAI (Voluntary Health Association of India), who called for a ban on baby food promotion.
After meeting with the International Baby Food Action Network(IBFAN) at Manila in 1989, Dr. Gupta decided to take his advocacy even further. He moved to Delhi and founded the Breastfeeding Promotion Network of India (BPNI) in consultation with four more paediatricians. He gave up clinical practice in the early 1990s and devoted himself to BPNI full time.
“Nutrition plays a key role in protection and improvement of child health, development and survival. For Infants and young children, the key nutrition comes from breastfeeding. Initiating breastfeeding within an hour of birth and providing skin-to-skin contact to babies is critical in saving more than 20% of newborn lives. Analysis has also shown that early breastfeeding is associated with protecting from undernutrition in young children. However, infant formula is introduced to newborns commonly and more so during cesarean births. WHO adopted the International Code of Marketing for Breastmilk Substitutes in 1981, which restricted the marketing and promotion of formulas and feeding bottles. The then PM, Mrs Indira Gandhi, supported this back home- but it took almost 11 years to get the law passed in the Parliament.“
The Infant Milk Substitutes, Feeding Bottles, and Infant Foods (Regulation of Production, Supply, and Distribution) Act of 1992 (IMS Act) was a landmark legislation that set the stage for safeguarding breastfeeding practices across the nation. It curbed corporate influence on young families, which prioritised profit over the health of populations. Companies could no longer make unsubstantiated claims or exploit emotional advertising to persuade mothers to switch from breastfeeding to formula feeding.
“This law has a major unseen contribution to infant and young child health by reducing the growth of consumption of infant formula in the country,” says Dr. Gupta. “India sells around 27,000 tonnes annually whereas China sells 560,000 tonnes. That’s because China does not have a strong law like we do. After 20 years of championing it, it was heartening to see the IMS Act help India to increase exclusive breastfeeding rates of infants till 6 months of age, which has a positive impact on their health and development.” Promoting exclusive breastfeeding for the first six months of life has been seen to reduce the incidence of diarrhoea, respiratory infections, and malnutrition, which were leading causes of child mortality.
“If a country can provide universal and optimal infant and young child feeding practices, it is likely to result in long-term gain in reducing non-communicable diseases as well. “
It did not come without its challenges; the IMS Act faced another threat in 2005. “Some company managed to get this (the IMS Act) inserted in the list of legislations to be repealed. My senior colleague, late Dr Jagdish Sobti, brought this news to the office. The joint secretary refused to even discuss this, but twenty-six organizations and several individuals stood up against this repeal.. we were on the roads for 3-4 months before a high-level political decision was taken to not repeal the Act.” Dr Gupta feels this was a groundbreaking moment- it demonstrated how determined advocacy could translate into tangible changes in public policy.
Dr. Gupta’s work thus far has enabled him to look at nutrition and how it has affected public health in India. “This allowed me to look at the overarching factors in the nutrition policy space, and in 2016, I convened a group called Nutrition Advocacy in Public Interest (NAPi), an informal think tank to comment on national policies around nutrition. NAPi analyses the nutrition policy recommendations and shares its thoughts with the policymakers.”
Dr Gupta believes that nutrition and the role it plays in our health can often be in conflict with profit-making objectives. “In principle, we oppose the conflicts of Interests in the development of policy. For example, NAPi created a Position Statement on managing Severe Acute Malnutrition to oppose introduction of ready to use therapeutic foods. Other work included advocating against celebrities advertising harmful products, expressing concerns on introducing processed packaged foods in government health programmes, and awareness on ultra-processed food products and related policy development.”
His life-long work has led Dr. Gupta to be alarmed at the acceptance and accessibility of ultra-processed foods. “People are still coming to grasp health as a concept, so education about unhealthy food products is rare. If the communications about diet myths and unhealthy food products are directed in local contexts and languages, I am sure this can certainly induce a sense of health literacy and can make a change. If people knew industrial-produced foods are formulations of several additives and food substances, they might choose healthier, unprocessed or minimally processed foods. Food labels must alert consumers to high salt/sugar or bad fats.
Marketing of unhealthy food products must be monitored because self-regulation does not work, and unhealthy food and drinks are all insidious advertised across print, television and social media. Advertisements are usually misleading, endorsed by celebs, and presented as parental approval. This must stop. Affordability is a political issue, as healthy food products are growing increasingly out of reach of the common people. But this is not everything,” he believes.
“Just one-off inputs won’t bring much change until good health care is available. When I talk to upcoming doctors, talking about prevention- the hallmark of public health- is not really common. For example, how many times does a doctor treating a child with diarrhoea find out what the water supply is like, how safe feeding is practised, what is the economic condition of the family, and what kind of diet the child is receiving? In the case of growth monitoring, if a child grows overweight, how often does a doctor examine the food environment and what kind of processed or ultra-processed foods or drinks are being eaten by the child?”
Dr. Arun Gupta embodies the spirit of public health- where your actions and activism are defined by the welfare of all above the interests of a few. His work has strengthened legislation, protected child health, and continues to promote safe and healthy nutrition for everyone. Individual determination and collective action can change our lives profoundly- and in Dr. Gupta’s case, it begins with what’s on our plates.
The Interviewee, Dr. Arun Gupta, is a paediatrician and public health scientist. After practising pediatrics, he founded the Breastfeeding Promotion Network of India (BPNI) in 1991. He also convened Nutrition Advocacy in Public Interest (NAPi) in 2015 to work towards nutrition policy.
Image by Janvi Bokoliya
